ERCPによる総胆管結石症の診断

A Study of the Diagnostic Evaluation of ERCP in Choledocholithiasis

　ERCP（endoscopic retrograde cholangio-pancreatography）は1969年に開発され，今日では胆道，膵疾患の診断には不可欠の検査法として広く臨床に活用されている．今回のテーマである総胆管結石症は日常高頻度に遭遇する疾患であり，ERCPは胆膵の両者にわたり広い情報を得ることができるので，結石の診断のみならず周辺の病態を知るうえからも必要な検査法と考えられる．

　ここでは教室の11年にわたるERCP経験例を中心に，総胆管結石診断の現況と，更に総胆管結石をめぐって周辺の病態がどこまで解明できるか，ERCPの総胆管結石診断における利点と問題点とについて検討する．

　In the last 11 years, 4,514 ERC and/or ERCP have been performed in Kagoshima University Hospital. It may he safely said that ERCP has been proved to be one of the most useful procedures to diagnose the diseases of the pancreas and biliary tract.

　Cholelithiasis is one of the most familiar diseases to practical clinic, and in our ERCP it accounts for 57% of all ERC cases.

　The paper is primary concerned with the diagnostic significance and problems of ERCP in cholelithiasis and especially choledocholithiasis. The results are summarized as follows:

　(1) Cholelithiasis accounted for 38% of 2,741 ERC cases, and 57% of these were choledocholithiasis.

　(2) ERC in choledocholithiasis revealed various choledochal findings. The prominent findings were dilatation of choledochus (97%), spontaneous internal fistula (6%) and juxtapapillary diverticulum (6%).

　(3) The incidence of abnormal ERP found in choledocholithiasis were: minimal changes (35%), moderate changes (7%) and advanced changes (1%).

　(4) As for differential diagnosis of choledocholithiasis, cases of bile-duct cancer, bile-duct cancer with calculi and calculus-like air bubble in contrast medium were presented.

　(5) As general problems of ERCP, endoscopic accident, biliary tract infection and how to treat ERC-negative cases were discussed too.

　(6) It may be reasonable to conclude that ERCP is one of the most significant procedures not only to find bile-calculus itself, but to inspect any possible disorder adjacent to the choledochus.